What action is recommended for a newborn that has a heart rate of 40 bpm after intubation and positive pressure ventilation?

For a newborn with a heart rate of 40 beats per minute after intubation and positive pressure ventilation, the recommended course of action is to start chest compressions while continuing with positive pressure ventilation.

In neonatal resuscitation, a heart rate below 60 bpm in a newborn, especially after intubation, indicates that the newborn may be in a critical state requiring immediate intervention. At this heart rate, the infant is experiencing bradycardia, which can be life-threatening. The combination of chest compressions and positive pressure ventilation is essential because it helps to restore adequate circulation and oxygenation to vital organs.

When chest compressions are initiated, it helps maintain blood flow despite the low heart rate, while continuing positive pressure ventilation ensures that the newborn is receiving adequate oxygen. This dual approach is aligned with resuscitation guidelines, which prioritize effective ventilation and circulation in emergencies.

Other choices, such as stopping resuscitation efforts, administering adrenaline immediately, or simply increasing the ventilation rate, do not address the immediate need to support circulation through chest compressions, making them less suitable responses in this scenario.